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Job Summary This position is responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role supports clinical review activities requiring 5+ years of...

Resp & Qualifications We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for...

Ensemble Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with FCC and care management to optimize patient care while controlling...

Molina Healthcare is seeking a Care Review Clinician (RN or LPN) for a remote, full-time position operating 8a-5p Pacific Time, Monday through Friday. You will support clinical member services review processes, verify medical necessity, and ensure...

Masimo is seeking a Clinical Research Lab RN to join our team in Irvine, CA. You will perform venous sampling, IV placement, and arterial-line tasks while supporting R&D funding, regulatory filings, and marketing initiatives for Masimo products.

U.S. Army Family Nurse Practitioners perform the highest level of quality care for Army Soldiers, retirees, and their families. If you are looking to combine your skills as a family nurse practitioner and your passion for...

Providence Tarzana Medical Center in Tarzana, CA is seeking a Certified Nursing Assistant for the Cardiovascular Unit. This Full-Time role requires CA Nursing Assistant Certification, BLS, and completion of the Nursing Assistant course, with...

To ensure timely and accurate care decisions, the full-time Utilization Review Nurse LVN/LPN will perform clinical reviews for medical necessity and benefit coverage, applying clinical guidelines and maintaining compliance in a remote work...

Netsmart is seeking a registered nurse to perform utilization review for emergency department admissions and ongoing stay reviews. You will evaluate EMRs, apply InterQual/MCG criteria, and collaborate with ED physicians to determine admission...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

Machinify is seeking a Medical Review Nurse to perform CMS/RAC audits for government payers. This remote role involves working with a multi-location team to review claims, document findings, and support appeals. RAC certification is preferred and...

About the Job ASSIGNMENT SUMMARY: The Registered Nurse (RN) will be responsible for coordinating, implementing and supervising all nursing and personal care services at the Adult Day Health Care Center. The...

Note : This is an educational program, not a job. Successful completion of the program does not guarantee employment but will equip you with valuable skills for the healthcare job market. Looking to start a rewarding career path in the...

Schedule: Flexible Shifts! You provide your manager with the days and start/end time you are available to complete your hours. All United States time zones are welcome. PRN opportunity to work 20-30hrs per week Job Location Type:...

CSL Behring is seeking a Nurse Resource Navigator to provide personalized education and support on gene therapy for the Hemophilia B community across the East Coast. You will educate patients, healthcare professionals, and families, guiding them...

About the job Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack...

HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer...

Ethos Risk Services is seeking a full-time Clinical Recruiter (REMOTE) to lead hiring for the Case Management division. You will own full-cycle recruiting for nurse case managers and other clinical pros, from posting to onboarding, ensuring a...

Baptist Health in Jacksonville, FL, is seeking a Registered Nurse for its Hospital At Home program. You will educate patients and families, advocate for patient needs, and coordinate care across medical and nursing teams in a home-based setting.

Position Title: Remote Telephonic RN Case Manager Mandatory Requirement: Must hold an Active Compact RN License and/or an Active California (CA) RN License to be considered. Pay Rate: $48.00 – $50.00 per hour...

Inland Empire Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims and support the UM/Claims interface. You will analyze records, determine authorization needs, and...

Job ID:26-134888 Job Title: Licensed Vocational Nurse Position Type: Full-Time Contract Role Location:Fully Remote Work Type: Work from Home Est. Pay Range: $25.00/Hour to $28.00/Hour on W2 (USD) Schedule: 8-hour shift Monday to Friday anywhere...

A-Line Staffing Solutions is seeking a Clinical Review Nurse for a concurrent review role in a remote-capable setting. The RN will assess member eligibility through chart review and coordinate with providers to gather necessary information.

Centene is seeking a Clinical Review Nurse - Concurrent Review to perform concurrent reviews, assess medical necessity, and contribute to discharge planning. This role supports Medicaid and Marketplace/Ambetter members in a remote setting.

Registered Nurse (RN)– Downey,CA Local Pay: $52.65/hour - (W2) Join our team and make a meaningful impact by delivering exceptional care in a professional healthcare...